Opioid withdrawal in adolescents
- Shan Yin, MD, MPH
Shan Yin, MD, MPH
- Assistant Professor of Pediatrics, University of Cincinnati School of Medicine
- Division of Emergency Medicine, Cincinnati Children's Hospital
- Medical Director, Cincinnati Drug and Poison Information Center
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Opioids have analgesic and central nervous system (CNS) depressant effects and the potential to cause euphoria. Morphine is the prototypic opioid. Heroin is a derivative of morphine and is a commonly abused opioid.
Opioids are effective in the treatment of acute and chronic pain as analgesics and sedatives and as anesthetic agents. They have the potential to be abused for these effects and the associated feeling of euphoria.
The epidemiology, pharmacology, clinical manifestations, and management of opioid withdrawal in adolescents are reviewed here. Opioid withdrawal in the neonate; acute opioid intoxication in children and adolescents; and opioid abuse, intoxication, withdrawal, and treatment in adults are discussed separately:
●(See "Neonatal abstinence syndrome".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- McCabe SE, West BT, Teter CJ, Boyd CJ. Medical and nonmedical use of prescription opioids among high school seniors in the United States. Arch Pediatr Adolesc Med 2012; 166:797.
- Whiteside LK, Walton MA, Bohnert AS, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics 2013; 132:825.
- Fortuna RJ, Robbins BW, Caiola E, et al. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics 2010; 126:1108.
- Substance Abuse and Mental Health Services Administration OoAS. Treatment Episode Data Set (TEDS). 1998 - 2008. National Admissions to Substance Abuse Treatment Services,. Rockville, MD: DASIS Series: S-50, HHS Publication No. (SMA) 09-4471; 2010.
- Brands B, Paglia-Boak A, Sproule BA, et al. Nonmedical use of opioid analgesics among Ontario students. Can Fam Physician 2010; 56:256.
- UK Focal Point on Drugs. United Kingdom Drug Situation 2012 Edition. London. http://www.nwph.net/ukfocalpoint/writedir/userfiles/file/Report%202012/REPORT2012FINAL.pdf. (Accessed on March 06, 2014).
- EMCDDA. Annual Report 2012. The State of the Drugs Problem in Europe. Luxembourg: Publications Office of the European Union.
- UNODC. World Drug Report 2013. Vienna, Austria: United Nations publication, Sales No E.13.XI.6.
- Williams JT, Christie MJ, Manzoni O. Cellular and synaptic adaptations mediating opioid dependence. Physiol Rev 2001; 81:299.
- Mazei-Robison MS, Nestler EJ. Opiate-induced molecular and cellular plasticity of ventral tegmental area and locus coeruleus catecholamine neurons. Cold Spring Harb Perspect Med 2012; 2:a012070.
- Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect 2002; 1:13.
- Kreek MJ, Koob GF. Drug dependence: stress and dysregulation of brain reward pathways. Drug Alcohol Depend 1998; 51:23.
- Minozzi S, Amato L, Davoli M. Detoxification treatments for opiate dependent adolescents. Cochrane Database Syst Rev 2014; :CD006749.
- Hovens JG, Cantwell DP, Kiriakos R. Psychiatric comorbidity in hospitalized adolescent substance abusers. J Am Acad Child Adolesc Psychiatry 1994; 33:476.
- Schwartz RH. Adolescent heroin use: a review. Pediatrics 1998; 102:1461.
- Deykin EY, Buka SL, Zeena TH. Depressive illness among chemically dependent adolescents. Am J Psychiatry 1992; 149:1341.
- Hoffmann, NG, Miller, NS. Treatment outcomes for abstinence-based programs. Psychiatr Ann 1992; 22:401.
- Smith DE, Schwartz RH, Gutgesell ME. Rehabilitation of chemically-dependent adolescents: a follow-up survey (abstract). Am J Dis Child 1989; 143:413.
- Spear SF, Ciesla JR, Skala SY. Relapse patterns among adolescents treated for chemical dependency. Subst Use Misuse 1999; 34:1795.
- Landry, MJ. Overview of addiction treatment effectiveness. Pub. No. (SMA) 96-3081. Rockville, MD: Substance abuse and mental health services administration, 1996.
- Hadland SE, Wharam JF, Schuster MA, et al. Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014. JAMA Pediatr 2017; 171:747.
- Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence. Lancet 1999; 353:221.
- Marsch LA, Bickel WK, Badger GJ, et al. Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial. Arch Gen Psychiatry 2005; 62:1157.
- Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA 2008; 300:2003.
- Hopfer CJ, Khuri E, Crowley TJ, Hooks S. Adolescent heroin use: a review of the descriptive and treatment literature. J Subst Abuse Treat 2002; 23:231.
- National Institute on Drug Abuse. National Results on Drug Use From Monitoring the Future Study, 1975-1992. NIH publication 93-3597, 199.
- SYMPTOMS OF OPIOID WITHDRAWAL
- CLINICAL FEATURES AND DIAGNOSIS
- Physical examination
- DIFFERENTIAL DIAGNOSIS
- Ethanol withdrawal
- Sedative-hypnotic withdrawal
- Sympathomimetic intoxication
- Cholinergic poisoning
- ACUTE MANAGEMENT OF OPIOID WITHDRAWAL
- Rapid detoxification
- MEDICALLY SUPERVISED DETOXIFICATION
- TREATMENT PROGRAMS
- Residential programs
- Outpatient day programs
- MAINTENANCE THERAPY
- Non-pharmacologic support